Appendix D: Survey for women

Introduction

Welcome to the survey for the evaluation of the National External Breast Prostheses Reimbursement Program.

The evaluation is being conducted by Urbis, an independent research firm, for the Department of Health and Ageing. The evaluation aims to find out how well the program is working for women who have had a mastectomy as a result of breast cancer and wear an external prosthesis.

Please take the time to complete this 10 minute survey if you:

Are an Australian resident

Have experienced breast cancer and currently wear, or have a need for, a breast prosthesis that is worn externally.

All information collected will remain strictly confidential and anonymous.

Part A - Awareness of the National External Breast Prostheses Reimbursement Program

QA1 Have you heard of the National External Breast Prostheses Reimbursement Program?

Yes

No (please go to PART D)

QA2 How did you hear about the National External Breast Prostheses Reimbursement Program?

Part B - Participation in the National External Breast Prostheses Reimbursement Program

The questions in part B relate to whether you have participated in the National External Breast Prostheses Reimbursement Program.

The National External Breast Prostheses Program is an Australian Government program that has been operating since 24 November 2008. It is administered by Medicare Australia on behalf of the Department of Health and Ageing. It provides reimbursements of up to $400 for new or replacement external breast prostheses for Australian women who have had a mastectomy as a result of breast cancer.

QB1 In the last 12 months, have you made a claim for reimbursement through the National External Breast Prostheses Reimbursement Program?

Yes (please go to PART C)

No

QB2 What was the reason/s that you did not make a claim for reimbursement through the program for an external breast prosthesis in the last 12 months?

(Please select all that apply)

I had not heard about the National External Breast Prostheses Reimbursement Program

I did not have useful information about the program

I had heard of the National External Breast Prostheses Reimbursement Program, but did not know how to make a claim through this program

I had difficulty accessing an application form for the program

I had difficulty completing an application form for the program

I had difficulty lodging an application form for the program

I did not need a breast prosthesis during this period

I claimed expenses for breast prostheses through private health insurance

I claimed expenses for breast prostheses through the Department of Veterans' Affairs

I did not wish to pay up front for the breast prosthesis, which is required before claiming under the National External Breast Prostheses Reimbursement Program

I was not able to pay to purchase the breast prosthesis, which is required before claiming under the National External Breast Prostheses Reimbursement Program

I made a claim through a state/ territory aids and appliance or external breast prostheses program

Part C - Experience of using the National External Breast Prostheses Reimbursement Program

QC1 How did you make your claim for reimbursement for an external breast prosthesis?

I downloaded an application form and posted it to a Medicare office

I completed the form at a Medicare office

I called or wrote to a Medicare Office and they sent me a form, which I completed and returned to them

I completed the form provided by my breast prosthesis supplier

Other (please specify)

QC2 On a scale of 1 to 5, where 5 is the best score, how would you rate the following aspects of the program?

(Select from 1-5 or not sure)

The availability of information about the program

The usefulness of information about the program

The ease of obtaining an application form

The ease of completing the application form

The ease of lodging the application form

The ease of obtaining the reimbursement following lodgement of your application

The timeliness of receiving reimbursement

The level of the reimbursement amount

The overall experience of the program

QC3 Did you receive a payment from the program as a result of your claim for reimbursement for an external breast prosthesis?

Yes (please go to QC5)

No

QC4 If your claim was unsuccessful, what was the reason provided?

I had received assistance through the Department of Veterans' Affairs

I had received assistance through another program in my state or territory

My breast prosthesis was purchased before 1 July 2008

I could not produce a receipt or proof of purchase for the breast prosthesis

Other (please specify)

After answering this question, please go to PART D.

QC5 Approximately how long did it take to receive reimbursement for the breast prosthesis into your bank account after you had lodged the claim?

Up to 10 business days

More than 10 business days (please estimate time)

QC6 On a scale of 1 to 5 where 1 is 'strongly disagree' and 5 is 'strongly agree' please indicate how much you agree or disagree with the following statements about the National External Breast Prostheses Reimbursement Program

(select from 1 to 5 or not sure)

The program made it easier to afford a breast prosthesis

It was difficult to afford the up-front payment required for a reimbursement under the program

The program had a positive impact on my quality of life

The process of getting reimbursed was straightforward

It was easy to gather the necessary supporting information for the claim

I was treated with sensitivity while making my claim

The level of the reimbursement for an external breast prosthesis under the program was sufficient

The frequency of reimbursement for an external breast prosthesis under the program (i.e. every 2 years) is sufficient

QC7 Do you have any other comments about the program?

Part D - About you

Please take a moment to complete the questions in Part D about you, even if you have not previously heard of or used the program. This will help us understand your responses and determine how well the program is currently meeting women's needs. All information collected in this survey will be treated as strictly confidential.

QD1 What kind of breast surgery have you had?

(Please select responses that apply to your most recent procedure)

Partial mastectomy

Full mastectomy

Double or bilateral mastectomy

Other (please specify)

Prefer not to say

QD2 How long ago did you have your breast surgery?

(If you have had more than one episode of breast cancer surgery, please indicate when you had your most recent procedure)

Less than 1 month ago

1-23 months ago

2-5 years ago

More than 5 years ago

Prefer not to say

QD3 How involved are you with the following groups?

(Select from not at all involved, slightly involved, very involved)

Breast Cancer Network Australia

Local breast cancer support groups

McGrath Foundation

Cancer Council

National Breast Cancer Foundation

Other breast cancer related groups or organisation/s (please specify)

Prefer not to say

QD4 Have you received financial assistance in the past for breast prostheses from state/ territory aids and appliances or external breast prostheses program/s?

Yes

No SKIP TO QD6

QD5 Which state/ territory program/s have you accessed?

(Please select all that apply)

NSW

Vic

WA

Qld

SA

Tas

NT

ACT

Prefer not to say

QD6 In which state do you currently live?

NSW

Vic

WA

Qld

SA

Tas

NT

ACT

Prefer not to say

QD7 Which of these terms best describes where you currently live?

(Please select one response only)

Major/ capital city

Regional city/ large country town

Small town

Regional city/ large country town

Remote village/ area away from a town

Prefer not to say

QD8 What level of education have you completed?

(Please select all that apply)

Year 10 (school certificate) or equivalent

Year 12 or equivalent

Apprenticeship or cadetship

TAFE or technical college

University

Other (please specify)

Prefer not to say

QD9 Which age range applies to you?

Under 30

30-39

40-49

50-59

60-69

70-79

80 or over

Prefer not to say

QD10 Do any of the following apply to you?

(Please select all that apply)

I identify as Aboriginal or Torres Strait Islander

I speak English as a second language

I identify as having a disability

Prefer not to say

QD11 Can you please tell us how you found out about this survey?

Thank you for completing the survey and contributing to the evaluation of the National External Breast Prostheses Reimbursement Program. If you have any queries about the survey, please contact Samantha Ross at Urbis on 02 8233 9915.